by Gail I. Smith, MA, RHIA, CCS-P
Let’s go back to the early years….1973 to be exact. I began my HIM career that year and discovered a love of coding. This was before encoding software, DRGs, HIPAA, APCs, or Official Coding Guidance.
There were two coders in the department of a 273-bed hospital in Cincinnati, Ohio, one was inpatient and one was outpatient. The inpatient coder, W., would come around the corner with a 4” thick paper inpatient medical record and ask me, the outpatient coder, “how would you code this?” We both enjoyed the back-and-forth discussion that reminded me of a type of coding grand rounds. It started with why the patient was admitted and what happened during the stay. The conclusion would be how we would code the case. Sometimes we encountered gray areas where we disagreed. How did we decide the final coding plan? We based our decisions on the clinical picture, coding guidelines, and how the classification system worked. From these grand round sessions, we were able to transfer our “system of decision-making” to other cases. I was proud of the work we did to promote quality coding and consistent data.
Fast forward to the 1980’s and along came DRGs and publications providing coding guidance that sometimes made us question our previous coding decisions. We decided not to blindly follow this advice if it did not have rationale that was supported by clinical knowledge or violated coding guidelines and how the classification system was designed.
Fast forward again to 2018 and the current state of coding. Coding professionals express their frustration with being audited at every turn, overregulated, and forced to adhere to guidance that sometimes makes no sense. Somehow, we lost our way.
I have a vision on how to move forward, but that will be shared in a series of future blogs. In the meantime, what is your strategy for reconciling conflicts between coding advice and the rules (Official Guidelines and Classification Conventions/Principles) which govern coding?
What ever happened to W? She went on to become a top-notch coding consultant because she followed the grand round system.
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